Volume 191 - Issue 10
Who is responsible for the care of patients treated with warfarin therapy?
Authors: Luke R E Bereznicki, Leanne Stafford, Ella C Jeffrey, Gregory M Peterson and Shane L Jackson
Med J Aust 2009; 191 (10): 575-577. || doi: 10.5694/j.1326-5377.2009.tb03321.x
Published online: 16 November 2009
Published online: 16 November 2009
To the Editor: The recent article by Lowthian and colleagues raises some important concerns regarding current management of warfarin therapy in Australia, especially the provision of quality warfarin education.1 While the study focused on the uncertainty surrounding who is responsible for this task, additional barriers to providing warfarin education include limited access to suitable resources and a tendency to rely on a single verbal counselling session and/or the supply of written material, often just before discharge from hospital.2
As Lowthian et al note, it is plausible that warfarin education was provided to the patients interviewed; it may simply have been inadequate to meet their needs or delivered at the wrong time or place. It is not always feasible for health care providers to reliably provide the necessary education in busy health care settings (eg, general practitioners when prescribing warfarin, pharmacists when supplying it). The authors note a potential role for practice nurses in providing this education; we would also like to highlight the role of accredited pharmacists, who can visit patients in their homes and provide targeted medication-related education. An annual Home Medicines Review can be provided for patients taking high-risk medications such as warfarin.3
Under the Fourth Community Pharmacy Agreement Research and Development Program, the Pharmacy Guild of Australia has funded two projects that are attempting to meet the education needs of patients taking warfarin. One project is trialling a comprehensive postdischarge service involving a series of follow-up home visits by trained accredited pharmacists, to provide not only warfarin education but also point-of-care international normalised ratio monitoring, in liaison with the patients’ GPs.
The other project is piloting a process whereby community pharmacists can identify potential candidates for patient self-monitoring of warfarin and, with GP collaboration, organise suitable training, with ongoing support from the pharmacist and GP. Patient self-monitoring, although not widely practised in Australia, has been shown to provide the best clinical outcomes for suitable candidates.4
An important component of these two projects is a website, launched in late 2008, containing a range of free, downloadable educational resources for both consumers taking warfarin and health care professionals responsible for its management (http://www.anticoagulation.com.au).
Education is crucial in achieving optimal health outcomes for patients taking warfarin, and health care professionals should cooperate to ensure their patients are well educated. This should involve regular reinforcement of consistent messages, and can also involve better use of existing services and educational tools.
References
- Lowthian JA, Diug BO, Evans SM, et al. Who is responsible for the care of patients treated with warfarin therapy? Med J Aust 2009; 190: 674-677. 0_CBBBHBCD
- Bajorek BV, Ogle SJ, Duguid MJ, et al. Management of warfarin in atrial fibrillation: views of health professionals, older patients and their carers. Med J Aust 2007; 186: 175-180. 0_i1091852
- Medicare Australia. For health professionals. Home Medicines Review (HMR). http://www.medicareaustralia.gov.au/provider/pbs/fourth-agreement/hmr.jsp (accessed Aug 2009).
- Heneghan C, Alonso-Coello P, Garcia-Alamino JM, et al. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet 2006; 367: 404-411. 0_i1091857